{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:44:24Z","timestamp":1792176264675,"version":"4.4.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T00:00:00Z","timestamp":1648684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Outcomes after kidney transplantation are largely driven by the development of\n                    <jats:italic>de novo<\/jats:italic>\n                    donor-specific antibodies (dnDSA), which may be triggered by blood transfusion. In this single-center study, we investigated the link between early blood transfusion and dnDSA development in a mainly anti-thymocyte globulin (ATG)-induced kidney-transplant cohort. We retrospectively included all recipients of a kidney transplant performed between 2004 and 2015, provided they had &amp;gt;3 months graft survival. DSA screening was evaluated with a Luminex assay (Immucor). Early blood transfusion (EBT) was defined as the transfusion of at least one red blood-cell unit over the first 3 months post-transplantation, with an exhaustive report of transfusion. Patients received either anti-thymocyte globulins (ATG) or basiliximab induction, plus tacrolimus and mycophenolic acid maintenance immunosuppression. A total of 1088 patients received a transplant between 2004 and 2015 in our center, of which 981 satisfied our inclusion criteria. EBT was required for 292 patients (29.7%). Most patients received ATG induction (86.1%); the others received basiliximab induction (13.4%). dnDSA-free graft survival (dnDSA-GS) at 1-year post-transplantation was similar between EBT+ (2.4%) and EBT- (3.0%) patients (chi-squared p=0.73). There was no significant association between EBT and dnDSA-GS (univariate Cox\u2019s regression, HR=0.88, p=0.556). In multivariate Cox\u2019s regression, adjusting for potential confounders (showing a univariate association with dnDSA development), early transfusion remained not associated with dnDSA-GS (HR 0.76, p=0.449). However, dnDSA-GS was associated with pretransplantation HLA sensitization (HR=2.25, p=0.004), hemoglobin &amp;gt;10 g\/dL (HR=0.39, p=0.029) and the number of HLA mismatches (HR=1.26, p=0.05). Recipient\u2019s age, tacrolimus and mycophenolic-acid exposures, and graft rank were not associated with dnDSA-GS. Early blood transfusion did not induce dnDSAs in our cohort of ATG-induced patients, but low hemoglobin level was associated with dnDSAs-GS. This suggests a protective effect of ATG induction therapy on preventing dnDSA development at an initial stage post-transplantation.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2022.852079","type":"journal-article","created":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T11:30:48Z","timestamp":1648726248000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Early Blood Transfusion After Kidney Transplantation Does Not Lead to dnDSA Development: The BloodIm Study"],"prefix":"10.3389","volume":"13","author":[{"given":"Thomas","family":"Jouve","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Noble","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Naciri-Bennani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line","family":"Dard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Masson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ga\u00eblle","family":"Fiard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Malvezzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lionel","family":"Rostaing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03840.x","article-title":"Understanding the Causes of Kidney Transplant Failure: The Dominant Role of Antibody-Mediated Rejection and Nonadherence","volume":"12","author":"Sellar\u00e9s","year":"2012","journal-title":"Am J Transplant"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13341","article-title":"The Synergistic Effect of Class II HLA Epitope-Mismatch and Nonadherence on Acute Rejection and Graft Survival","volume":"15","author":"Wiebe","year":"2015","journal-title":"Am J Transplant"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa020009","article-title":"The Natural History of Chronic Allograft Nephropathy","volume":"349","author":"Nankivell","year":"2003","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001243","article-title":"Calcineurin Inhibitor Nephrotoxicity Through the Lens of Longitudinal Histology: Comparison of Cyclosporine and Tacrolimus Eras","volume":"100","author":"Nankivell","year":"2016","journal-title":"Transplantation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"481","DOI":"10.2215\/CJN.04800908","article-title":"Calcineurin Inhibitor Nephrotoxicity","volume":"4","author":"Naesens","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001244","article-title":"Calcineurin Inhibitor Nephrotoxicity in the Era of Antibody-Mediated Rejection","volume":"100","author":"Naesens","year":"2016","journal-title":"Transplantation"},{"key":"B7","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1681\/ASN.2017070818","article-title":"A Randomized Trial of Bortezomib in Late Antibody-Mediated Kidney Transplant Rejection","volume":"29","author":"Eskandary","year":"2018","journal-title":"J Am Soc Nephrol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002049","article-title":"The Treatment of Antibody-Mediated Rejection in Kidney Transplantation: An Updated Systematic Review and Meta-Analysis","volume":"102","author":"Wan","year":"2018","journal-title":"Transplantation"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13436","article-title":"The Therapeutic Challenge of Late Antibody-Mediated Kidney Allograft Rejection","volume":"32","author":"B\u00f6hmig","year":"2019","journal-title":"Transpl Int"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.trim.2013.09.008","article-title":"Peri-Operative Third Party Red Blood Cell Transfusion in Renal Transplantation and the Risk of Antibody-Mediated Rejection and Graft Loss","volume":"29","author":"Fidler","year":"2013","journal-title":"Transpl Immunol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13795","article-title":"Impact of Early Blood Transfusion After Kidney Transplantation on the Incidence of Donor-Specific Anti-HLA Antibodies","volume":"16","author":"Ferrandiz","year":"2016","journal-title":"Am J Transplant"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15233","article-title":"Shared Alloimmune Responses Against Blood and Transplant Donors Result in Adverse Clinical Outcomes Following Blood Transfusion Post\u2013Renal Transplantation","volume":"19","author":"Hassan","year":"2019","journal-title":"Am J Transplant"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31818046db","article-title":"Preferential Benefit of Antibody Induction Therapy in Kidney Recipients With High Pretransplant Frequencies of Donor-Reactive Interferon-Gamma Enzyme-Linked Immunosorbent Spots","volume":"86","author":"Augustine","year":"2008","journal-title":"Transplantation"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfw445","article-title":"Characteristics of Donor-Specific Anti-HLA Antibodies and Outcome in Renal Transplant Patients Treated With a Standardized Induction Regimen","volume":"32","author":"Zecher","year":"2017","journal-title":"Nephrol Dial Transplant"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2022.852079\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T11:30:50Z","timestamp":1648726250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2022.852079\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,31]]},"references-count":14,"alternative-id":["10.3389\/fimmu.2022.852079"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2022.852079","relation":{"has-review":[{"id-type":"doi","id":"10.32388\/35UUUV","asserted-by":"object"}]},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,31]]},"article-number":"852079"}}